Individual provider Active NPI

Cherokee Breeze Roman, LCSW

  • Clinical Social Worker
  • Concord, NC
National Provider Identifier
1194461236
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C017523 Issued in NC
Practice address
11 Union St S Ste 200
Concord, NC 28025-5098
Phone
(704) 918-9741
Fax
(704) 270-6213
NPI assigned
May 11, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X C017523 NC Primary

Addresses

Primary practice location

11 Union St S Ste 200
Concord, NC 28025-5098

Mailing address

11 Union St S Ste 200
Concord, NC 28025-5098
Phone (704) 918-9741

Other names 1

  • Cherokee Breeze Staples Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241114001595 NC Practitioner - Clinical Social Worker 2365976214 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Victory Family Counseling Clinical CurrentSince Sep 1, 2024 Accepting new patients
Art of Therapy Center PastSince May 1, 2022 Accepting new patients

Locations

11 Union St S
Ste 200
Concord, NC 28025
Phone (704) 918-9315

11 Union St S
Ste 206
Concord, NC 28025
Phone (704) 918-9741

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1194461236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 UNION ST S STE 200",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280255098",
            "telephone_number": "704-918-9741",
            "fax_number": "704-270-6213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 UNION ST S STE 200",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280255098",
            "telephone_number": "704-918-9741",
            "fax_number": "704-270-6213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMAN",
        "first_name": "CHEROKEE",
        "middle_name": "BREEZE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-11",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C017523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHEROKEE",
            "last_name": "STAPLES",
            "middle_name": "BREEZE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.